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Letters to the Editor   |    
Oral Direct Thrombin Inhibitor Ximelagatran Compared with Warfarin for the Prevention of Venous Thromboembolism After Total Knee Arthroplasty
Paul A. Lotke, MD; John J. Callaghan, MD; Lawrence D. Dorr, MD; Gerard H. Engh, MD; Arlen D. Hanssen, MD; William L. Healy, MD; Paul F. Lachiewicz, MD; Jess H. Lonner, MD; Charles Nelson, MD; Chitranjan S. Ranawat, MD; Merrill A. Ritter, MD; Eduardo A. Salvati, MD; Thomas P. Sculco, MD; Thomas S. Thornhill, MD
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (AstraZeneca and Sanofi). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1163-1163
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Extract

To The Editor:After reading the article by Colwell et al., "Oral Direct Thrombin Inhibitor Ximelagatran Compared with Warfarin for the Prevention of Venous Thromboembolism After Total Knee Arthroplasty" (2005;87:2169-77), we are concerned that the facts presented by the authors do not appear to justify their conclusions and that some important parameters of patient evaluations are lacking.In this report, the authors note that 0.3% of the patients in the ximelagatran group died from a cause in which pulmonary embolism could not be ruled out whereas there were no deaths from pulmonary embolism in the warfarin group. This incidence is relatively high when compared with that reported in most recent studies, which have demonstrated a 0.1% incidence of fatal pulmonary embolism following total joint surgery. More detailed information regarding these deaths would be helpful to assist the reader in differentiating the patients in whom pulmonary embolism could not be ruled out from patients with fatal pulmonary embolism.
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